40 EyeWorld Asia-Pacific | June 2025 GLAUCOMA take longer. Intravitreal injections, such as triamcinolone or dexamethasone implants, can lead to a delayed but significant IOP rise. Dr. Chen also pointed out that elevated eye pressure is usually asymptomatic, especially if the increase occurred gradually. “Most patients do not experience any symptoms. In cases of rapid and extreme elevation in eye pressure, patients may experience a severe headache and eye pain in the affected eye, which can be accompanied by tearing, redness, and vision changes such as blurred vision or halos around lights,” she said. Dr. Chen agreed that this issue usually occurs several weeks after steroid use. “Most studies suggest that a steroid response occurs after 3–6 weeks of steroid exposure,” she said. “In high-risk patients, particularly those with a known history of response, IOP can rise within days.” Most Likely Offenders And Risk Factors Dr. Kahook noted that certain steroids are more strongly associated with elevated IOP. Potent topical agents, like prednisolone acetate 1% and dexamethasone, are higher risk compared to fluorometholone or loteprednol, which are less likely to elevate IOP due to their structural modifications.Intravitreal steroids, especially triamcinolone and dexamethasone implants, are also high-risk. Systemic steroids may cause IOP elevation, but their impact is typically less than that of potent local treatments, he added. Patients with certain predisposing factors are at higher risk of developing steroid-induced glaucoma. Dr. Kahook said these include individuals with primary open angle glaucoma, a family history of glaucoma, and high myopia, among other conditions. Pediatric patients are also susceptible, and care should be taken in this patient population to check IOP when using steroids chronically since they may not show obvious symptoms. Dr. Chen noted that steroids administered to the eye have the strongest association with steroid response. Among them, eye drops are the most common mode of administration associated with steroid response, primarily due to their widespread use. “The incidence of elevated eye pressure is higher for intraocular steroid injections, which can have sustained release of corticosteroid up to several years. In general, steroid exposure near the eyes and head region are at higher risk of eliciting a steroid response; some easily overlooked causes include corticosteroid nasal sprays, inhalers, or creams, which are used to treat allergy, nasal congestion, asthma, chronic obstructive pulmonary disease, or dermatologic conditions. Because many are available over the counter, patients may not realize they pose a risk.” she said. Oral and intravenous steroids are less likely to cause steroid response compared to topical steroids. Those patients who require prolonged or repeated ocular steroid treatment are at increased risk of developing steroid-induced glaucoma. Some common ophthalmic scenarios include corneal transplantation, uveitis (inflammatory ocular disease), and macular edema (retinal swelling), according to Dr. Chen. She also noted that patients who use topical steroid creams on the head/face or over a large surface area of the body should be aware. “I recommend avoiding the eye area when applying the medication and making sure to wash hands carefully to avoid unintentional ocular exposure.” Treatment The way to treat, Dr. Noecker said, is to stop the steroid, then you can treat the patient with an NSAID or another short-term solution. Fortunately, pressure often decreases once the steroid is discontinued. But he said you never know how long it will take for it to come back down, and it depends on how vulnerable they are. Drops or SLT can be used to help these patients. You should continue to see
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